Induction with rabbit antithymocyte globulin following orthotopic liver transplantation for hepatitis C

Hepatitis C [HCV] is the most common indication for liver transplantation in the US. Since steroids are the major stimulus of viral replication, we postulated that steroid-free immunosuppression might be a safer approach. From January 1995 to October 2002, we used steroid plus calcineurin inhibitor [CNI] immunosuppression after liver transplantation for HCV [steroid group, n=81]. From October 2002 to June 2007, rabbit antithymocyte globulin [RATG] induction, followed by CNI and azathioprine [RATG group, n=73] was utilized. There were no differences in 1- and 3-year patient/allograft survival rates. The incidence of acute rejection rate [19% vs. 28%], of biopsy-proven HCV recurrence [70% vs. 75%], and chronic rejection [6% vs. 9%] were comparable. The mean time to develop recurrent HCV was significantly longer in the RATG group [16.2 vs. 9.2 months, p=0.008]. The incidence of severe portal fibrosis appears to be lower in RATG group compared to the steroid group; 14% vs. 4% [p=0.07]. RATG induction is safe and effective after liver transplantation for HCV, but has no impact on the incidence of HCV recurrence and patient/allograft survival. However, a significant delay in time to HCV recurrence and a trend toward less rejection and portal fibrosis was observed

Liver donor partial hepatectomy for liver transplantation: is there a learning curve?

Donor safety is the first priority in living donor liver transplantation [LDLT]. To determine the characteristics and outcome of live liver donors who underwent donor hepatectomy from January, 1997 to May, 2007 at Massachusetts General Hospital. 30 patients underwent LDLT between January, 1997 and May, 2007 at our institution. The type of graft was the right lobe [segments 5-8] in 14, left lobe [segments 2-4] in 4, and left lateral sector [segments 2 and 3] in 12 patients. The mean donor age was 36 [range: 26]57] years. The mean follow-up was 48 [range: 18-120] months. No deaths occurred. Overall, 8 [26.6%] patients experienced a total of 14 post-operative complications. Donor complications based on graft type were as follows: left lateral sector [16.7%], left lobed [25%], and right lobe [35.7%]. The experience was divided into two periods 1997-2001 [n=15] and 2002-2007 [n=15]. Overall complications during 2 periods were 40% and 13.3% respectively [p<0.001]. The incidence of grade III complication also significantly decreased; 66.7% vs 33.3% [p<0.01]. Partial hepatectomy in living donors has a learning curve which appears to be approximately 15 cases. This learning curve is not restricted to the surgeons performing the procedure but involves all aspects of patient care

Donor kidney recovery methods and the incidence of lymphatic complications in kidney transplant recipients

Lymphatic leak and lymphocele are well-known complications after kidney transplantation. To determine the incidence of lymphatic complications in recipients of living donor kidneys. Among 642 kidney transplants performed between 1999 and 2007, the incidence of lymphatic com- plications was retrospectively analyzed in recipients of living donor kidneys procured by laparoscopic ne- phrectomy [LP, n=218] or by open nephrectomy [OP, n=127] and deceased donor kidneys [DD, n=297]. A Jackson-Pratt drain was placed in the retroperitoneal space in all recipients and was maintained until the output became less than 30 mL/day. Although the incidence of symptomatic lymphocele, which required therapeutic intervention, was comparable in all groups, the duration of mean +/- SD drain placement was significantly longer in the LP group 8.6 +/- 2.7 days compared to 5.6 +/- 1.2 days in the OP group and 5.4 +/- 0.7 days in the DD group [p<0.001]. Higher output of lymphatic drainage in recipients of LP kidneys could lead to a higher incidence of lymphocele if wound drainage is not provided. More meticulous back table preparation may be required in LP kidneys to decrease lymphatic com- plications after kidney transplantation. These observations also support the suggestion that the major source of persistent lymphatic drainage following renal transplantation is severed lymphatics of the allograft rather than those of the recipient's iliac space